Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Epidemiol. 2021 Feb;36(2):143-147. doi: 10.1007/s10654-021-00735-7. Epub 2021 Mar 16.
There has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that "there is no scientific evidence", by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, "the science supports that face coverings save lives". It used to be a 'given' that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.
在新冠疫情期间,没有哪个问题像口罩这样有争议。最有争议的科学争论是在那些认为“没有科学证据”的人(他们的意思是没有随机对照试验 (RCT))和那些认为“综合考虑证据时,科学支持口罩可以拯救生命”的人之间展开的。过去,人们普遍认为,要确定一个特定的因素(外源性的或内源性的)是否可以导致某种特定的疾病,以及其影响的程度,应该考虑所有合理的相关证据。这种方法正受到科学界和政治界越来越多的挑战。科学上的挑战来自于一种方法学观点,这种观点将随机对照试验 (RCT) 作为科学的金标准,优先考虑 RCT 产生的证据,或者与 RCT 非常相似的观察性研究产生的证据。政治上的挑战则来自于各种利益集团,他们呼吁将流行病学证据排除在监管和咨询委员会的考虑之外。